Milium cysts: how to get rid of them?

Themechanical extraction of a milium grain is carried out by a health professional to ensure that the procedure is performed safely. This technique involves making punctures on the milium grains using a needle, then manually expelling the content with a comedone extractor, a curette, or a cotton swab.

The primary benefit of this method is that it is swift and the results are almost instantaneous. Numerous studies have demonstrated that this technique does not leave permanent scars post-extraction and the risk of milia recurrence is minimal. However, we would like to remind you that it is strongly advised against piercing a milium grain by yourself, as it poses a risk of infections.

Topical retinoids are also used, particularly in cases of plaque milia. They help to detach the keratin plug in the milium grain by stimulating the proliferation of free corneocytes, which results in the expulsion of the microcyst. Their effectiveness has been scientifically proven.

Indeed, Kay S. KANE and her colleagues found that the topical application of a 0.025% tretinoin cream every night for six weeks on a child with milia on the nose significantly reduced their number. Complete disappearance was observed after eight weeks and was maintained a year later.

This technique does not result in scarring, has no particular side effects, and allows for a complete and lasting resolution. However, it should be noted that products containing tretinoin are generally medications subject to medical prescription. Like all medications, they can cause adverse effects and are subject to usage precautions.

This information is particularly dependent on the proposed concentrations (0.025%, 0.5% and 0.1%), and other potentially unsuitable compounds in the preparations available on the market. Therefore, please inform yourself before use if you are pregnant, breastfeeding or considering use on your child. Discuss it with your doctor or pharmacist if you have the slightest doubt.

Cryotherapy involves inducing a targeted destruction of tissues by cooling the skin and freezing the cells. Liquid nitrogen is the most commonly used cryogenic agent. Dermatologists apply liquid nitrogen to milia using a cotton swab or a spray. The milia then peel off.

In a study, Guiseppe NOTO observed that a 75-second session of cryotherapy on a woman with milia made them disappear within eight weeks of healing, with no recurrence two years later.

The method does not require local anaesthesia. You will only feel a slight burning sensation for a few minutes, but the procedure is not painful. This technique is simple and safe. It does not particularly require post-operative care, only to avoid excessive sun exposure. However, cryotherapy on milia is not as commonly practised as extraction.

Less common methods of milia removal include the use of a CO2laser. It utilises pulses of laser light. These beams penetrate the skin's surface, where the water contained in the skin cells absorbs them. The epidermis is then vaporised. The dermis warms up, stimulating the growth of collagen fibres. Within a few days, the skin heals and becomes smooth.

The ablation is performed under local anaesthesia. It is easy to carry out and allows for the treatment of multiple lesions swiftly. However, it can cause sensations of burning, redness in the affected area, and skin discomfort for the following two to three months. Moreover, the healing process can last up to two weeks and a sun protection is essential for the six months following the ablation.

Electrodessication represents an option that involves using a specialised needle to deliver an electric current into the keratinised centre of a milium grain. The electric current causes the breakdown of the microcyst and its reintegration into the body, and the milia fall off after one or two days.

This technique is swift and effective. Although it may seem a bit daunting, it is a safe procedure. However, the scientific evidence on the use of electrodessication on milia is somewhat limited.

Antibiotics, such as the minocycline, can be used to eliminate milia. This is a tetracycline family antibacterial antibiotic in capsule form, which also has anti-inflammatory activity by inhibiting the expression of pro-inflammatory cytokines.

Studies have shown that taking 100mg of minocycline orally per day, following the application of a retinoid cream, can completely eliminate milia within a month. However, the mechanism of action of minocycline on milia remains unknown.

It is important to note that since June 2012, medications containing minocycline are no longer recommended for the treatment of acne, as they can lead to potentially severe allergic skin reactions, including skin rashes, fever, and swollen lymph nodes. Therefore, it would be prudent to discuss this with your doctor or pharmacist before using this medication.

Note : Furthermore, if you have been applying corticosteroids to your skin over a long period and you notice a flare-up of milia, consult your doctor to see if a change in treatment is necessary. Indeed, studies have shown that the long-term topical application of corticosteroids could promote thedevelopment of milia.

Let us recall that milium cysts disappear on their own in the vast majority of cases and that no treatment is necessary.

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• KANE K. S. & al. Milia en plaque of the nose: Report of a case and successful treatment with topical tretinoin. American Academy of Pediatrics (2014).

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